Recent data suggest that overall rates of obesity among children and adolescents have slowed, but worrisome trends have emerged in the form of severe pediatric obesity. “Severe obesity is the fastest-growing subcategory of obesity in children and adolescents, affecting 4% to 6% of all youths in the United States,” says Aaron S. Kelly, PhD. Severe obesity in childhood has both immediate and long-term health consequences, including a greater risk for adverse cardiometabolic risk factors and earlier signs of vascular dysfunction and subclinical atherosclerosis. High BMI and adiposity levels in childhood have been associated with a higher risk of cardiovascular disease (CVD), diabetes, and premature death. “Unfortunately,” says Dr. Kelly, “many of the treatment approaches commonly used in overweight and obese youths are less effective for cases in which severe obesity is present. Treatment options for children with severe obesity are limited, and most standard approaches to weight loss are insufficient for them. Novel treatment strategies must be tailored for severe obesity in order to alter the health trajectory of children and adolescents afflicted with this disease.” Defining Severe Obesity To begin addressing the challenges of managing this patient population, the American Heart Association (AHA) published a scientific statement in Circulation. “A key component of the statement was to develop a standardized definition of severe obesity in children and adolescents,” says Dr. Kelly, who co-chaired the AHA writing group’s scientific statement. The statement defines children older than 2 (and adolescents) as severely obese if they either have a BMI that is at least 20% higher than the 95th percentile for their gender and age, or a BMI of 35 kg/m2...